| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,055 |
1,435 |
$245K |
| D1110 |
Prophylaxis - adult |
3,358 |
3,174 |
$149K |
| D0330 |
Panoramic radiographic image |
3,150 |
2,951 |
$125K |
| D1120 |
Prophylaxis - child |
2,358 |
2,215 |
$111K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,868 |
1,127 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
4,135 |
3,891 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,636 |
2,484 |
$70K |
| D0274 |
Bitewings - four radiographic images |
1,837 |
1,787 |
$49K |
| D7140 |
Extraction, erupted tooth or exposed root |
786 |
243 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
705 |
393 |
$28K |
| D1351 |
Sealant - per tooth |
1,479 |
354 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,984 |
2,774 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
249 |
199 |
$15K |
| D2332 |
|
142 |
83 |
$9K |
| D1206 |
Topical application of fluoride varnish |
507 |
499 |
$9K |
| D2331 |
|
160 |
99 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,161 |
712 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
318 |
307 |
$5K |
| D0272 |
Bitewings - two radiographic images |
109 |
101 |
$2K |
| D2330 |
|
21 |
13 |
$861.08 |
| D0482 |
|
12 |
12 |
$260.45 |